Features Differentiating a Generalized Seizure from Vasovagal and Cardiac Syncope (Stokes-Adams Attack)
| Generalized seizure | Vasovagal syncope | Cardiac syncope (Stokes-Adams attack) | |
|---|---|---|---|
| Occurrence when sitting or lying | Common | Rare | Common |
| Occurrence during sleep | Common | Does not occur | May occur |
| Prodromal symptoms | May occur with focal neurological symptom, automatisms or hallucinations | Typical with sweating, dizziness, nausea, blurring of vision, yawning | Often none; palpitation may occur |
| Focal neurological features at onset | May occur (signifies focal cerebral lesion) | Never occurs | Never occurs |
| Tonic-clonic movements | Characteristic; occurs within 30s of onset | May occur after 30s of syncope (secondary anoxic seizure) | May occur after 30s of syncope (secondary anoxic seizure) |
| Facial colour | Flushing or cyanosis at onset | Pallor at onset | Pallor at onset; flushing afterwards |
| Tongue biting | Common | Rare | Rare |
| Urinary incontinence | Common | Uncommon | May occur |
| Injury | May occur | Uncommon | May occur |
| After the attack | Confusion common | Nauseated and ‘groggy’ | Usually well |